Obsessive-Compulsive Disorder: Driven by Intrusion

Bill WhiteApril 3, 2011

John drove into his subdivision on the way home from work. He hit a small pothole. In sudden terror, he believed he ran over a child. For the next 45 minutes John drove randomly through his neighborhood, coming back to the site.

In his mind, he had to be sure a little one wasn’t injured or dead.

That’s just part of the story John shared in an email. In his early 20s, the incident was his right of passage into the world of anxiety and obsessive-compulsive disorder.

An informative and thorough series on Obsessive-Compulsive Disorder (OCD) is prime chipur material. So let’s get started today by seeing what it looks like.

What Is OCD?

Approximately 2.3% of the world’s adult population endures OCD. That’s right at 92 million people! And let’s not forget the children and adolescents who suffer.

And yet, OCD is probably the most under-reported of the emotional/mental health disorders. Embarrassment, stigma, and lack of information are among the culprits.

In coming to understand OCD, the first order of business is getting a handle on obsessions and compulsions. I used the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) as reference…

Obsessions

Obsessions are recurrent and persistent thoughts, impulses, or images – well beyond the, say, life-worries most experience. The phenomena are received as intrusive and inappropriate. And they generate buckets of anxiety and/or distress.

The person experiencing the misery knows it’s all a mind-creation. And she/he will go to great lengths to ignore, suppress, or somehow neutralize the obsession(s).

In John’s case, the mind-creation/obsession was his irrational concern over injuring or killing a child.

Compulsions

Compulsions are repetitive behaviors or mental acts (e.g.: counting the tiles in a ceiling) one feels driven to perform in response to an obsession. Also involved may be a set of personal rules that must be rigidly applied.

Compulsions are aimed at preventing or reducing distress, or preventing a dreaded event or situation. Fact is, neither of them are realistically connected with what they’re designed to prevent or reduce. And if by chance they are, their expression is excessive.

Back to our friend John. Can you guess what his compulsion was? What was it in response to? That’s right, it was repetitively returning to the pothole site. And it was driven by the obsession that he injured or killed a child.

OCD Diagnosis

So now that we have the pieces, let’s build the disorder. One is said to have OCD if the experience of either an obsession or compulsion meets this criteria…

The person, at some point, has realized the obsession or compulsion is excessive or defies logic.

The obsession or compulsion is causing significant distress, taking-up more than an hour per day, or seriously impairing routine life functioning.

The obsession or compulsion experience can’t have anything to do with another emotional/mental health disorder, using a substance, or a general medical condition.

In general, typically seen are – preoccupation with orderliness, perfectionism, and mental and interpersonal control at the expense of flexibility, openness, and efficiency.

Okay, more specifically – lists, rules, organization, incomplete tasks, lost leisure activities and relationships, rigid morals and ethics, inability to discard worthless and/or unneeded objects, inability to work with others unless it’s on their rigid terms, and being excessively tight with money.

Until Tomorrow

Well, that’s a ton of information to absorb. So let’s leave it at that for today. But there’s much more to share and learn. Be sure to come back tomorrow, as we’ll get into the causes of OCD. We may even have time to begin our treatment chat.